Parents of an 8-year-old boy called me with concerns regarding his refusal to go to school. They were confused about what they considered a “sudden” change in behavior. Their son had always loved his school and made many friends. He played on teams with his schoolmates on the weekends and had a generally carefree childhood.
They were sure it was bullying. Despite repeated statements that he wasn’t being bullied or teased in any way, his parents continued to worry that bullying was the only possible explanation for his marked shift in demeanor. In first grade, he couldn’t wait to get to school each day. He ran off without even saying goodbye most days. One month into second grade, he was clingy, tearful and prone to tantrums the moment they reached the school. In his parents’ minds, it had to be an issue with his peers.
It wasn’t. This little boy suffered from separation anxiety disorder.
Parents are often told to watch for separation anxiety in babies and toddlers. It’s fairly common for kids to go through a stage where they’re clingy and afraid of new people or unfamiliar environments. What parents are not warned about, however, is that separation anxiety can resurface in school-age kids. In some cases, the anxiety becomes so persistent that children suffer from separation anxiety disorder.
[See: 13 Tips for Getting Kids Health-Ready for Back to School.]
What Is Separation Anxiety Disorder?
Separation anxiety disorder is a condition in which a child becomes fearful or experiences excessive worry when away from an attachment figure, typically a parent. The fear causes significant distress for the child and can negatively affect how the child does at school, in social relationships and in other areas of functioning.
Separation anxiety disorder is more than a few tears at school drop-off. Children suffering from separation anxiety disorder experience a wide array of symptoms and feel overwhelmed by their fears and worries.
Watch for these symptoms of separation anxiety disorder if you suspect that your child is struggling:
— An unrealistic and lasting worry that something terrible will happen to the parent or caregiver (often fears of death) if the child leaves
— An unrealistic and lasting worry that something terrible will happen to the child
— School refusal
— Difficulty sleeping alone (wants a parent or caregiver in the bed or in the bedroom); has difficulty or refuses to sleep away from home
— Nightmares about being separated from a parent or caregiver
— Difficulty making and maintaining friendships due to persistent worry
— Lack of independence
— Afraid to be alone, such as on another floor of the house, in a room or outside in the backyard by themselves
— Tantrums or meltdowns before or during separations (anticipation of separation can trigger tantrums)
— Physical ailments: headaches, stomachaches, muscle pains from tension, racing heart, shortness of breath or dizziness (particularly on school days or just prior to separation)
— Emotions: worry, fear, anger, embarrassment or shame
Approximately 4 percent of children under the age of 12 suffer from separation anxiety disorder. Onset of separation tends to peak on entering kindergarten, between the ages of 7 and 9, and again with entry to middle and high school.
[Read: The Importance of Mental Health Days.]
How to Help Your Child
While some cases of separation anxiety disorder can be fairly mild and don’t require professional treatment, many cases do. Try these strategies at home to help your child cope with separation anxiety:
Name it. Kids know when they’re struggling with anxiety, but they don’t always know what to call it. When parents talk openly about anxious feelings and the behaviors that result, kids learn to bring their feelings to the surface. When parents brush anxiety under the rug or attempt to “fix” it or cover it up, kids feel ashamed.
Use the words “separation anxiety,” and help your child connect the dots between the feelings he experiences and the worries that drive his emotions. Ask your child to name his biggest worries, and remain calm and open-minded when he describes them. When a child says, “I’m afraid you will die in a car accident when I’m at school,” for example, resist the urge to minimize that fear and instead meet it with empathy.
It’s important to normalize these feelings for kids. It’s perfectly natural to feel worried about being away from an attachment figure all day. It’s also OK to need help learning to manage that worry.
Create a consistent routine. Children with separation anxiety disorder are often plagued with anticipatory anxiety. The “what ifs” keep them up at night and cause them to draw their own (often unrealistic) conclusions about potential threats. A consistent routine, including proper sleep hygiene, daily exercise, periods of downtime and healthy eating, are important.
Build a strong relationship with the school. A teacher can be a huge source of support for a child, but only if that teacher knows what’s happening. Be open with the classroom teacher and work to build the home-school connection.
Encourage healthy risks. Risk-taking doesn’t have to include things like jumping from the high dive. Healthy risks may involve stepping just outside of the comfort zone to try something new and interesting or expanding upon a current hobby or interest. This can be anything from taking a new art or cooking class to trying a new sport to writing poetry. Let go of your internalized hopes for your child, and instead ask your child how she wants to spend her time.
Teach relaxation strategies. Children with separation anxiety disorder need to learn how to cope with the physical and emotional responses to anxious thoughts that can occur when they’re away from home.
— Teach deep breathing to calm the racing heart and shortness of breath.
— Teach progressive muscle relaxation to relieve muscle tension.
— Teach guided imagery to help your child take a mini-break in his mind when he feels overwhelmed
Encourage positive self-talk. Teach your child how to confront intrusive thoughts in the moment. The best way to do this is to help your child identify intrusive thoughts that frequently pop into his head during the school day, like “My mom might have a heart attack while I’m at school.” Next, come up with positive alternatives to these thoughts, like saying to oneself, “My mom is very healthy and gets plenty of exercise.” Finally, practice this positive self-talk when calm to take control over negative thought patterns.
Get help. If separation anxiety disorder interferes with your child’s ability to attend school or focus while at school, negatively affects peer or family relationships, or affects other areas of functioning, it’s time to seek an evaluation from a licensed mental health practitioner. Cognitive behavioral therapy is effective in helping children learn to reshape their thinking and cope with separation. Family therapy can teach the family about the disorder and how to best to support the child. In severe cases, medication might be recommended.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
As kids head back to school, it’s important to promote a positive outlook, listen to and empathize with their concerns, and intervene if it seems that separation anxiety interferes with their ability to attend school and focus in the classroom.
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What You Need to Know About Separation Anxiety Disorder originally appeared on usnews.com
